Provider Demographics
NPI:1295771509
Name:PAULK, WILSON GUINN (MD)
Entity type:Individual
Prefix:DR
First Name:WILSON
Middle Name:GUINN
Last Name:PAULK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:W
Other - Middle Name:GUINN
Other - Last Name:PAULK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:262 MITYLENE PARK DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-3548
Mailing Address - Country:US
Mailing Address - Phone:334-260-8511
Mailing Address - Fax:334-260-8755
Practice Address - Street 1:262 MITYLENE PARK DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-3548
Practice Address - Country:US
Practice Address - Phone:334-260-8511
Practice Address - Fax:334-260-8755
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL16479207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051519733Medicaid
AL51520076OtherBLUE CROSS BLUE SHIELD
AL51520076OtherBLUE CROSS BLUE SHIELD